This piece is devastating and necessary. It doesn’t argue for cages—it exposes how abandonment, jails, ERs, and secrecy have become our default “system.” The shift from dangerousness to clinical need is the most important insight here. Real care means infrastructure, dignity, and intervention before crisis—not punishment after it.
This is one of the few pieces that refuses the false comfort of simple villains.
You hold love, fear, exhaustion, and responsibility in the same frame without collapsing into sentiment or punishment. That matters.
What you’re really asking is “Can we build systems that intervene without disappearing people?” Italy’s distinction, need for care rather than threat, feels like the ethical hinge.
Cages fail because they’re built around control, not continuity. Abandonment fails because it disguises itself as freedom. What you’re pointing toward is the harder third thing: sustained care that stays human even when behavior isn’t.
Thank you for telling this from inside the mess, not above it. That’s where policy actually begins.
Thank you, Elham. You distilled the main question perfectly: "Can we build systems that intervene without disappearing people?" Perfectly put!
We are always trying to control everything, white knuckle, take a heavy hand. This is why progressives hate the idea of civil committment - we can't imagine one that isn't prison or torture. This is a failure of our imaginations. Thanks for reading. :)
Hi. I've been thinking about how to answer your question all day. I can hear the heartbreak bewteen the lines. I suppose the real truth is that you can't. You can't force her. And this is probably the hardest thing for a parent. When Lucy had symptoms, she often was unaware she was ill. And that makes this diagnosis very hard. My best advice is to approach her when she is stable and not depressive or manic and see if you can get her to do a longterm injectible. If the drug symptoms bug her, you can maybe help her get new meds or a new doc. I think ultimatums and anger will only push her away. You have to always remember she isn't doing this on purpose. And I always say this to other parents of special needs kids - get yourself a therapist who can help YOU help her and also give you advice so can create healthy boundaries for yourself. This is an exremely challenging road as a parent, but she can lead a productive and beautiful life and she can get there with your support and love. But a professional guiding YOU will give you lots of new tools to handle this is the best way for her and the family. Here if you need to talk some more. Thank you for reaching out. I'll be thinking of you. - Kim
Thank you for being real, raw and sharing insights of what is complicated and possible. As someone who is turning 61 in January, 60 can be the beginning of a decade of what you want . . . to change, correct and re-imagine. Keep writing and sharing. You remain an inspiration.
So much relevance gets packed in your postings Ms.F. – I enjoy every one and do my best to promote your words of sanity in this messy world, this messy time. And your video showed such heart and noble intent! I wish you well in the new year, with your new age, and can't wait to read your new book. Blessings be yours!
This is such a powerful critic of where "we" are as a nation. Your writing is both "visiting the library" and "having a cozy coffee with a friend." And you embracing 60 is such a beautiful thing!❤️ Love you 😘
You are truly an extremely gifted human with a huge heart and an incredible moral compass. The world would be a better place if more were like you. A hero many.... thank you for sharing your wisdom and gifts with the world... Happy Birthday!
Happy 60th! I turned 60 walking the El Camino de Santiago, and entered the decade feeling strong, confident that I could do anything I set my mind to, and surrounded by the love of my fellow travelers. There have been hard things about the decade— losses have come hard and fast— but that beginning has carried me for the last three years. I wish you all good things as you mark this milestone. We’re so lucky to get to grow old.
I really appreciate your article, “Cages.” You name the challenges so well, and I had no idea about Italy’s systems of care. Thank you for that.
I worked in mental health/illness for 35 years, getting my start at a community mental health center (CMHC) in the 80’s, before CMH had been gutted. One of my first jobs was walking city streets with a colleague, looking for mentally ill homeless people. When we met someone, we’d buy them lunch, get to know them, ask f they were interested in getting in the shelters (which were more abundant then), and ask when they’d last seen a doctor. If they were open to it, we’d call the mobile unit and a psychiatrist and a case worker would come wherever we were in a van equipped with all kinds of resources that could be really helpful. By the end of the interaction, they were housed, had access to meds, and follow up appointments scheduled within the next few days. Nothing like that exists now.
We talk about “the mental health system,” but there is no system. At least not a proper, functioning one. The best development in the last 15 years or so has been EPIP’s, early psychosis intervention programs. Some are state-wide programs offered through community mental health, others are private (and expensive). But they do tend to be much more effective than anything else out there, offering a multi-pronged approach that includes psychotherapy and medication but also education-intensives about how the illness and how to manage it, occupational therapy, career counseling, family support and education, etc. They last 3-6 months, and are designed for people who’ve had their first psychotic episode (usually due to bipolar disorder or schizophrenia). My clients (college and university students, as I’d moved on from CMHC work), who went through an EPIP rarely had second episodes— which was remarkable. It’s costly to do 6 months of intensive treatment, but if the programs can actually teach people and their families how to manage their illnesses, it saves money in the long-run.
And money is what drives, or fails to drive, all of this. No psychiatric beds in hospitals because they’re not money-makers. A dearth of providers because you can’t make a living wage in community mental health. No safety nets for chronically mentally ill folks because they’re disposable— certainly not the stock-holding types. So many failures of care, systems, and treatment abound. There are much better ways and it’s shameful that we don’t do better as a culture, leaving it all on the backs of individuals and families.
Again, thanks for sharing your experiences and shining light on this. It’s so important.
Happy Birthday you gorgeous, caring, kind, intelligent, creative woman. Thank you for writing in a way that speaks so clearly and openly about life, in all its glory and devastation. I am such an admirer of yours. I always will be. Much love Kim x
Sixty means more freedom. I look at my friends, some of whom I have had in my life for over 50 years. 60 means a lifetime of memories and so much time left to make more. 60 means that filter, we were supposed to have and use, is worn out. We can be honest with others, but more importantly, with ourselves. 60 allows us to forgive ourselves.
60 means that I’ve known you for a long time. Thank you for that friendship. Merry Christmas and Happy Birthday/New Year. 💗🐘
Kim, I've found reason to comment so many times on your posts. Less often have I felt equal to the task of commenting no your posts. This one, however, calls for engagement.
On a much smaller scale (I'm not a parent) I've been forced to navigate some of the situations you're describing in the most urgent circumstances with respect to my former girlfriend Alexia from 12 years ago. I've set her story aside for the telling after I do some Las Vegas stories, but your interest in this topic almost forces my hand.
For the sake of quick qualification of my claims of relevance, I'd invite you to have a look at these videos:
In between the 2012 version of Alexia--a young woman who at the time was comorbid horoin SUD and borderline disorder, and the 2023 version of Alexia--a young woman who was, by then, comorbid fentanyl SUD and shizoaffective disorder, were dozens of my attempts at voluntary / involuntary detention and involuntary / voluntary detox-withdrawal.
I'd love to speak with you about these experiences offline, because the outcome, for me, of dedicated self-education on the subject in the aftermath might serve to lend structure to some of your questions. That's not to say that it would provide answers, because for a mother there are no answers. There is only whatever a mother must do.
Richard
Las Vegas
PS: My comments are scattered around the 2023 video comment section and to some extent tell the story, for example this one:
______
@damagejacked (me)
After 18 months, I have yet to encounter a comment that asks any of these questions:
—Whether this interviewee is capable of consenting to be interviewed
— What compensation was provided, and would this compensation be considered help or enablement?
— Who benefits from this interview? The viewer, the interview subject or the business interest of the interviewer?
— On what basis can this interviewer justify this session, his recording of this session, or his uploading of this session without providing public assurance of his accredited training in solo encounters with individuals like this interview subject?
Your writing is always both smart and wise, and deeply humane. And your recounting of your children's challenges and progress is testament to the reality that it is both nature and the quality of nurture that determines life trajectories. They may have been born with dysregulated nervous systems due to genetics and/or prenatal environmental factors, but mitigation can happen in a supportive and loving family. I have complicated reactions to what happened to Rob Reiner and his wife Michelle. I knew Rob when we were both teenagers -- in an improvisational theater workshop when we were both in high school. There was never a question in anyone's mind that he would be successful. He was likable, smart, funny, and obviously had the best kind of family connections to the industry. Later, in adulthood, I had to let go of my unrealized dream of a career in show business, and I went to college and university and became a licensed clinical psychiatric social worker. I worked in substance abuse programs, and in psychiatric hospital wards, with seriously mentally ill and character disordered patients in both voluntary and involuntary treatment settings. I know how it feels to try to help an intractably disordered person, even more complicated when there are bonds of family.
Whenever I am notified of a new post by you, dear Kim, I make it a priority to read it ASAP, because I know it will be thoughtful and informed, well written, and include many points of view. Thank you.
I believe you will find turning 60 will give you renewed confidence, hormones become more balanced, and will open up a season of trying new things, because, why not? And if not now, when? You have so much to give and the we appreciate you very much.
I'm a mental health professional so especially appreciated this article. Severe and persistent mental health is tricky and there are no easy answers. But there can be increased supports for families in local communities and we need to elect officials who are supportive of providing quality mental health services.
Happy birthday! I'm 63 now and turning 60 meant I had lived longer than my dad and my half-sister. We all three had the same kind of heart attacks -- LAD or widowmaker -- during our 50's but they both passed away right away. I lived.
I would say that I've learned to live life to the fullest, do everything I wanted to, and have forgiven everyone who ever wronged me. But, except for the forgiving-everyone-who-ever-wronged-me part, I have done that. I never thought I would make it to this age (because of the aforementioned heart issues) so I went for broke from the very beginning of my life. I can't think of a single thing that I have ever wanted to do -- some legal and some not-so-legal--that I have not done!
My wish for you is that if you have not been, you run like your hair is on fire into your 60's doing any damn thing you want to!! Lots of love, Kelli
I’m 84 years old and still dealing with childhood issues - those of my kids, my grandkids, and my own. I appreciate your candor and your commitment. This ordinary everyday task of parenting requires a strong heart. Never give up.
Happy 60th!! 😊😊
This piece is devastating and necessary. It doesn’t argue for cages—it exposes how abandonment, jails, ERs, and secrecy have become our default “system.” The shift from dangerousness to clinical need is the most important insight here. Real care means infrastructure, dignity, and intervention before crisis—not punishment after it.
This is one of the few pieces that refuses the false comfort of simple villains.
You hold love, fear, exhaustion, and responsibility in the same frame without collapsing into sentiment or punishment. That matters.
What you’re really asking is “Can we build systems that intervene without disappearing people?” Italy’s distinction, need for care rather than threat, feels like the ethical hinge.
Cages fail because they’re built around control, not continuity. Abandonment fails because it disguises itself as freedom. What you’re pointing toward is the harder third thing: sustained care that stays human even when behavior isn’t.
Thank you for telling this from inside the mess, not above it. That’s where policy actually begins.
Thank you, Elham. You distilled the main question perfectly: "Can we build systems that intervene without disappearing people?" Perfectly put!
We are always trying to control everything, white knuckle, take a heavy hand. This is why progressives hate the idea of civil committment - we can't imagine one that isn't prison or torture. This is a failure of our imaginations. Thanks for reading. :)
Yes, the imagination failure is exactly it.
I appreciate you keeping the question open.
I have a 22 yr.old bipolar daughter who refuses to take medication, and I'd like to know if there are ways to convince her to start?
Hi. I've been thinking about how to answer your question all day. I can hear the heartbreak bewteen the lines. I suppose the real truth is that you can't. You can't force her. And this is probably the hardest thing for a parent. When Lucy had symptoms, she often was unaware she was ill. And that makes this diagnosis very hard. My best advice is to approach her when she is stable and not depressive or manic and see if you can get her to do a longterm injectible. If the drug symptoms bug her, you can maybe help her get new meds or a new doc. I think ultimatums and anger will only push her away. You have to always remember she isn't doing this on purpose. And I always say this to other parents of special needs kids - get yourself a therapist who can help YOU help her and also give you advice so can create healthy boundaries for yourself. This is an exremely challenging road as a parent, but she can lead a productive and beautiful life and she can get there with your support and love. But a professional guiding YOU will give you lots of new tools to handle this is the best way for her and the family. Here if you need to talk some more. Thank you for reaching out. I'll be thinking of you. - Kim
Thank you for being real, raw and sharing insights of what is complicated and possible. As someone who is turning 61 in January, 60 can be the beginning of a decade of what you want . . . to change, correct and re-imagine. Keep writing and sharing. You remain an inspiration.
So much relevance gets packed in your postings Ms.F. – I enjoy every one and do my best to promote your words of sanity in this messy world, this messy time. And your video showed such heart and noble intent! I wish you well in the new year, with your new age, and can't wait to read your new book. Blessings be yours!
This is such a powerful critic of where "we" are as a nation. Your writing is both "visiting the library" and "having a cozy coffee with a friend." And you embracing 60 is such a beautiful thing!❤️ Love you 😘
I miss you so much, Lyz. Also library + cozy coffee is THE BEST. Thank you.
You are truly an extremely gifted human with a huge heart and an incredible moral compass. The world would be a better place if more were like you. A hero many.... thank you for sharing your wisdom and gifts with the world... Happy Birthday!
Happy 60th! I turned 60 walking the El Camino de Santiago, and entered the decade feeling strong, confident that I could do anything I set my mind to, and surrounded by the love of my fellow travelers. There have been hard things about the decade— losses have come hard and fast— but that beginning has carried me for the last three years. I wish you all good things as you mark this milestone. We’re so lucky to get to grow old.
I really appreciate your article, “Cages.” You name the challenges so well, and I had no idea about Italy’s systems of care. Thank you for that.
I worked in mental health/illness for 35 years, getting my start at a community mental health center (CMHC) in the 80’s, before CMH had been gutted. One of my first jobs was walking city streets with a colleague, looking for mentally ill homeless people. When we met someone, we’d buy them lunch, get to know them, ask f they were interested in getting in the shelters (which were more abundant then), and ask when they’d last seen a doctor. If they were open to it, we’d call the mobile unit and a psychiatrist and a case worker would come wherever we were in a van equipped with all kinds of resources that could be really helpful. By the end of the interaction, they were housed, had access to meds, and follow up appointments scheduled within the next few days. Nothing like that exists now.
We talk about “the mental health system,” but there is no system. At least not a proper, functioning one. The best development in the last 15 years or so has been EPIP’s, early psychosis intervention programs. Some are state-wide programs offered through community mental health, others are private (and expensive). But they do tend to be much more effective than anything else out there, offering a multi-pronged approach that includes psychotherapy and medication but also education-intensives about how the illness and how to manage it, occupational therapy, career counseling, family support and education, etc. They last 3-6 months, and are designed for people who’ve had their first psychotic episode (usually due to bipolar disorder or schizophrenia). My clients (college and university students, as I’d moved on from CMHC work), who went through an EPIP rarely had second episodes— which was remarkable. It’s costly to do 6 months of intensive treatment, but if the programs can actually teach people and their families how to manage their illnesses, it saves money in the long-run.
And money is what drives, or fails to drive, all of this. No psychiatric beds in hospitals because they’re not money-makers. A dearth of providers because you can’t make a living wage in community mental health. No safety nets for chronically mentally ill folks because they’re disposable— certainly not the stock-holding types. So many failures of care, systems, and treatment abound. There are much better ways and it’s shameful that we don’t do better as a culture, leaving it all on the backs of individuals and families.
Again, thanks for sharing your experiences and shining light on this. It’s so important.
Happy Birthday you gorgeous, caring, kind, intelligent, creative woman. Thank you for writing in a way that speaks so clearly and openly about life, in all its glory and devastation. I am such an admirer of yours. I always will be. Much love Kim x
Sixty means more freedom. I look at my friends, some of whom I have had in my life for over 50 years. 60 means a lifetime of memories and so much time left to make more. 60 means that filter, we were supposed to have and use, is worn out. We can be honest with others, but more importantly, with ourselves. 60 allows us to forgive ourselves.
60 means that I’ve known you for a long time. Thank you for that friendship. Merry Christmas and Happy Birthday/New Year. 💗🐘
Kim, I've found reason to comment so many times on your posts. Less often have I felt equal to the task of commenting no your posts. This one, however, calls for engagement.
On a much smaller scale (I'm not a parent) I've been forced to navigate some of the situations you're describing in the most urgent circumstances with respect to my former girlfriend Alexia from 12 years ago. I've set her story aside for the telling after I do some Las Vegas stories, but your interest in this topic almost forces my hand.
For the sake of quick qualification of my claims of relevance, I'd invite you to have a look at these videos:
Alexia 'Starchild' Dubasso ca 2012
(A year before we met):
https://youtu.be/TACMeN9OqrY?si=RtHN95IimVgihzSA
Alexia DuBasso--no longer 'Starchild' in March, 2023
(Five years after that last time I threw in on her sobriety for the sake of one of her 'rape babies'):
https://www.youtube.com/watch?v=QKjSMQojNtw
In between the 2012 version of Alexia--a young woman who at the time was comorbid horoin SUD and borderline disorder, and the 2023 version of Alexia--a young woman who was, by then, comorbid fentanyl SUD and shizoaffective disorder, were dozens of my attempts at voluntary / involuntary detention and involuntary / voluntary detox-withdrawal.
I'd love to speak with you about these experiences offline, because the outcome, for me, of dedicated self-education on the subject in the aftermath might serve to lend structure to some of your questions. That's not to say that it would provide answers, because for a mother there are no answers. There is only whatever a mother must do.
Richard
Las Vegas
PS: My comments are scattered around the 2023 video comment section and to some extent tell the story, for example this one:
______
@damagejacked (me)
After 18 months, I have yet to encounter a comment that asks any of these questions:
—Whether this interviewee is capable of consenting to be interviewed
— What compensation was provided, and would this compensation be considered help or enablement?
— Who benefits from this interview? The viewer, the interview subject or the business interest of the interviewer?
— On what basis can this interviewer justify this session, his recording of this session, or his uploading of this session without providing public assurance of his accredited training in solo encounters with individuals like this interview subject?
Your writing is always both smart and wise, and deeply humane. And your recounting of your children's challenges and progress is testament to the reality that it is both nature and the quality of nurture that determines life trajectories. They may have been born with dysregulated nervous systems due to genetics and/or prenatal environmental factors, but mitigation can happen in a supportive and loving family. I have complicated reactions to what happened to Rob Reiner and his wife Michelle. I knew Rob when we were both teenagers -- in an improvisational theater workshop when we were both in high school. There was never a question in anyone's mind that he would be successful. He was likable, smart, funny, and obviously had the best kind of family connections to the industry. Later, in adulthood, I had to let go of my unrealized dream of a career in show business, and I went to college and university and became a licensed clinical psychiatric social worker. I worked in substance abuse programs, and in psychiatric hospital wards, with seriously mentally ill and character disordered patients in both voluntary and involuntary treatment settings. I know how it feels to try to help an intractably disordered person, even more complicated when there are bonds of family.
Whenever I am notified of a new post by you, dear Kim, I make it a priority to read it ASAP, because I know it will be thoughtful and informed, well written, and include many points of view. Thank you.
I believe you will find turning 60 will give you renewed confidence, hormones become more balanced, and will open up a season of trying new things, because, why not? And if not now, when? You have so much to give and the we appreciate you very much.
I'm a mental health professional so especially appreciated this article. Severe and persistent mental health is tricky and there are no easy answers. But there can be increased supports for families in local communities and we need to elect officials who are supportive of providing quality mental health services.
Happy birthday! I'm 63 now and turning 60 meant I had lived longer than my dad and my half-sister. We all three had the same kind of heart attacks -- LAD or widowmaker -- during our 50's but they both passed away right away. I lived.
I would say that I've learned to live life to the fullest, do everything I wanted to, and have forgiven everyone who ever wronged me. But, except for the forgiving-everyone-who-ever-wronged-me part, I have done that. I never thought I would make it to this age (because of the aforementioned heart issues) so I went for broke from the very beginning of my life. I can't think of a single thing that I have ever wanted to do -- some legal and some not-so-legal--that I have not done!
My wish for you is that if you have not been, you run like your hair is on fire into your 60's doing any damn thing you want to!! Lots of love, Kelli
I’m 84 years old and still dealing with childhood issues - those of my kids, my grandkids, and my own. I appreciate your candor and your commitment. This ordinary everyday task of parenting requires a strong heart. Never give up.